Thrombogenicity of radiofrequency ablation procedures: what factors influence thrombin generation?

Aims Thromboembolic complications have been reported after radiofrequency ablation but the low incidence of overt clinical events has been a limitation to the study of factors affecting thrombogenic risk. The aim of this study was to determine whether radiofrequency ablation has a procoagulant effect and to examine variables that affect thrombin generation. Methods and Results Thirty-seven consecutive patients who underwent radiofrequency ablation were studied prospectively. Blood samples were assayed for thrombin-antithrombin III (TAT) and d-dimer (DD) at five different time points: (1)baseline; (2) after sheath insertion; (3) after electrophysiological study but before radiofrequency ablation; (4) at completion of the procedure; and (5) 24 h post-procedure. TAT levels were within the normal range at baseline and increased significantly after sheath insertion From 2(.)1 +/- 1(.)2 mug 1(-1) to 13(.)3 +/- 16(.)0 mug 1(-1) (P <0(.)01). Levels increased further to 24(.)0 +/- 19(.)9 mug 1(-1) (P <0(.)01) after electrophysiological study but did not increase after radiofrequency ablation. TAT normalized at 24 h. DD increased significantly from baseline values (230(.)2 +/- 176(.)8 ng ml(-1)) to 285(.)4 +/- 237(.)4 ng ml(-1) (P=0(.)019) after sheath insertion. There was a further significant increase after electrophysiological study to 423(.)4 +/- 324(.)3 ng ml(-1) (P <0(.)01), and a slight but non-significant increase to 464(.)4 +/- 307(.)4 ng ml(-1) after radiofrequency ablation (P=0(.)159). DD remained elevated at 24 h. Procedure duration was the only variable that correlated with the relative increase in TAT and DD. The patients with the longest procedure durations had more catheters inserted, more radiofrequency applications and largely consisted of accessory bypass tract-mediated tachycardias. Heparin administration significantly blunted the relative increase in TAT after radiofrequency ablation (p=0(.)005). Conclusion Radiofrequency ablation procedures confer an increased risk of thrombosis. Catheterization and diagnostic study contribute largely to the thrombogenic stimulus. Thrombogenicity is increased in prolonged, complex procedures and is decreased in patients who have been administered heparin during the procedure. (C) 2000 The European Society of Cardiology.